Bad breath (halitosis) can be an unpleasant and embarrassing condition.  Many of us may not realize that we have bad breath, but everyone has it from time to time, especially in the morning.

There are various reasons one may have bad breath, but in healthy people, the major reason is due to microbial deposits on the tongue, especially the back of the tongue.  Some studies have shown that simply brushing the tongue reduced bad breath by as much as 70 percent.

What may cause bad breath?

• Morning time – Saliva flow almost stops during sleep and its reduced cleansing action allows bacteria to grow, causing bad breath.
• Certain foods – Garlic, onions, etc.  Foods containing odor-causing compounds enter the blood stream; they are transferred to the lungs, where they are exhaled.
• Poor oral hygiene habits – Food particles remaining in the mouth promote bacterial growth.
• Periodontal (gum) disease – Colonies of bacteria and food debris residing under inflamed gums.
• Dental cavities and improperly fitted dental appliances – May also contribute to bad breath.
• Dry mouth (Xerostomia) – May be caused by certain medications, salivary gland problems, or continuous mouth breathing.
• Tobacco products – Dry the mouth, causing bad breath.
• Dieting – Certain chemicals called ketones are released in the breath as the body burns fat.
• Dehydration, hunger, and missed meals – Drinking water and chewing food increases saliva flow and washes bacteria away.
• Certain medical conditions and illnesses – Diabetes, liver and kidney problems, chronic sinus infections, bronchitis, and pneumonia are several conditions that may contribute to bad breath.

Keeping a record of what you eat may help identify the cause of bad breath.  Also, review your current medications, recent surgeries, or illnesses with you dentist.

What can I do to prevent bad breath?

• Practice good oral hygiene – Brush at least twice a day with an ADA approved fluoride toothpaste and toothbrush.  Floss daily to remove food debris and plaque from in between the teeth and under the gumline.  Brush or use a tongue scraper to clean the tongue and reach the back areas.  Replace your toothbrush every 2 to 3 months.  If you wear dentures or removable bridges, clean them thoroughly and place them back in your mouth in the morning.
• See your dentist regularly – Get a check-up and cleaning at least twice a year.  If you have or have had periodontal disease, your dentist will recommend more frequent visits.
• Stop smoking/chewing tobacco – Ask your dentist what they recommend to help break the habit.
• Drink water frequently – Water will help keep your mouth moist and wash away bacteria.
• Use mouthwash/rinses – Some over-the-counter products only provide a temporary solution to mask unpleasant mouth odor.  Ask your dentist about antiseptic rinses that not only alleviate bad breath, but also kill the germs that cause the problem.

In most cases, your dentist can treat the cause of bad breath.  If it is determined that your mouth is healthy, but bad breath is persistent, your dentist may refer you to your physician to determine the cause of the odor and an appropriate treatment plan.

Brushing and flossing help control the plaque and bacteria that cause dental disease.

Plaque is a film of food debris, bacteria, and saliva that sticks to the teeth and gums.  The bacteria in plaque convert certain food particles into acids that cause tooth decay.  Also, if plaque is not removed, it turns into calculus (tartar).  If plaque and calculus are not removed, they begin to destroy the gums and bone, causing periodontal (gum) disease.

Plaque formation and growth is continuous and can only be controlled by regular brushing, flossing, and the use of other dental aids.

Toothbrushing – Brush your teeth at least twice a day (especially before going to bed at night) with an ADA approved soft bristle brush and toothpaste.

• Brush at a 45 degree angle to the gums, gently using a small, circular motion, ensuring that you always feel the bristles on the gums.
• Brush the outer, inner, and biting surfaces of each tooth.
• Use the tip of the brush head to clean the inside front teeth.
• Brush your tongue to remove bacteria and freshen your breath.

Electric toothbrushes are also recommended.  They are easy to use and can remove plaque efficiently.  Simply place the bristles of the electric brush on your gums and teeth and allow the brush to do its job, several teeth at a time.

Flossing – Daily flossing is the best way to clean between the teeth and under the gumline.  Flossing not only helps clean these spaces, it disrupts plaque colonies from building up, preventing damage to the gums, teeth, and bone.

• Take 12-16 inches (30-40cm) of dental floss and wrap it around your middle fingers, leaving about 2 inches (5cm) of floss between the hands.
• Using your thumbs and forefingers to guide the floss, gently insert the floss between teeth using a sawing motion.
• Curve the floss into a “C” shape around each tooth and under the gumline.  Gently move the floss up and down, cleaning the side of each tooth.

Floss holders are recommended if you have difficulty using conventional floss.

Rinsing – It is important to rinse your mouth with water after brushing, and also after meals if you are unable to brush.  If you are using an over-the-counter product for rinsing, it’s a good idea to consult with your dentist or dental hygienist on its appropriateness for you.

Over the years there has been some concern as to the safety of amalgam (silver) fillings.  An amalgam is a blend of copper, silver, tin and zinc, bound by elemental mercury.  Dentists have used this blended metal to fill teeth for more than 100 years.  The controversy is due to claims that the exposure to the vapor and minute particles from the mercury can cause a variety of health problems.

According to the American Dental Association (ADA), up to 76% of dentists use silver containing mercury to fill teeth.  The ADA also states that silver fillings are safe and that studies have failed to find any link between silver containing mercury and any medical disorder.

The general consensus is that amalgam (silver) fillings are safe.  Along with the ADA’s position, the Center for Disease Control (CDC), the World Health Organization, the FDA, and others support the use of silver fillings as safe, durable, and cost effective.  The U.S. Public Health Service says that the only reason not to use silver fillings is when a patient has an allergy to any component of this type of filling.  The ADA has had fewer than 100 reported incidents of an allergy to components of silver fillings, and this is out of countless millions of silver fillings over the decades.

Although studies indicate that there are no measurable health risks to patients who have silver fillings, we do know that mercury is a toxic material when we are exposed at high, unsafe levels.  For instance, we have been warned to limit the consumption of certain types of fish that carry high levels of mercury in them.  However, with respect to amalgam fillings, the ADA maintains that when the mercury combines with the other components of the filling, it becomes an inactive substance that is safe.

There are numerous options to silver fillings, including composite (tooth-colored), porcelain, and gold fillings.  We encourage you to discuss these options with your dentist so you can determine which is the best option for you.

You should have your teeth checked and cleaned at least twice a year, though your dentist or dental hygienist may recommend more frequent visits.

Regular dental exams and cleaning visits are essential in preventing dental problems and maintaining the health of your teeth and gums.  At these visits, your teeth are cleaned and checked for cavities.  Additionally, there are many other things that are checked and monitored to help detect, prevent, and maintain your dental health.  These include:

• Medical history review: Knowing the status of any current medical conditions, new medications, and illnesses, gives us insight to your overall health and also your dental health.
• Examination of diagnostic x-rays (radiographs): Essential for detection of decay, tumors, cysts, and bone loss.  X-rays also help determine tooth and root positions.
• Oral cancer screening: Check the face, neck, lips, tongue, throat, tissues, and gums for any signs of oral cancer.
• Gum disease evaluation: Check the gums and bone around the teeth for any signs of periodontal disease.
• Examination of tooth decay: All tooth surfaces will be checked for decay with special dental instruments.
• Examination of existing restorations: Check current fillings, crowns, etc.
• Removal of calculus (tartar): Calculus is hardened plaque that has been left on the tooth for sometime and is now firmly attached to the tooth surface.  Calculus forms above and below the gum line, and can only be removed with special dental instruments.
• Removal of plaque: Plaque is a sticky, almost invisible film that forms on the teeth.  It is a growing colony of living bacteria, food debris, and saliva.  The bacteria produce toxins (poisons) that inflame the gums.  This inflammation is the start of periodontal disease!
• Teeth polishing: Removes stain and plaque that is not otherwise removed during toothbrushing and scaling.
• Oral hygiene recommendations: Review and recommend oral hygiene aids as needed (electric dental toothbrushes, special cleaning aids, fluorides, rinses, etc.).
• Review dietary habits: Your eating habits play a very important role in your dental health.

As you can see, a good dental exam and cleaning involves quite a lot more than just checking for cavities and polishing your teeth.  We are committed to providing you with the best possible care, and to do so will require regular check-ups and cleanings.

Four out of five people have periodontal disease and don’t know it!  Most people are not aware of it because the disease is usually painless in the early stages.  Unlike tooth decay, which often causes discomfort, it is possible to have periodontal disease without noticeable symptoms.  Having regular dental check-ups and periodontal examinations are very important and will help detect if periodontal problems exist.

Periodontal disease begins when plaque, a sticky, colorless, film of bacteria, food debris, and saliva, is left on the teeth and gums.  The bacteria produce toxins (acids) that inflame the gums and slowly destroy the bone.  Brushing and flossing regularly and properly will ensure that plaque is not left behind to do its damage.

Other than poor oral hygiene, there are several other factors that may increase the risk of developing periodontal disease:

• Smoking or chewing tobacco – Tobacco users are more likely than nonusers to form plaque and tartar on their teeth.

• Certain tooth or appliance conditions – Bridges that no longer fit properly, crowded teeth, or defective fillings that may trap plaque and bacteria.

• Many medications – Steroids, cancer therapy drugs, blood pressure meds, oral contraceptives.  Some medications have side affects that reduce saliva, making the mouth dry and plaque easier to adhere to the teeth and gums.

• Pregnancy, oral contraceptives, and puberty – Can cause changes in hormone levels, causing gum tissue to become more sensitive to bacteria toxins.

• Systemic diseases – Diabetes, blood cell disorders, HIV / AIDS, etc.

• Genetics may play role – Some patients may be predisposed to a more aggressive type of periodontitis.  Patients with a family history of tooth loss should pay particular attention to their gums.

Signs and Symptoms of Periodontal Disease

• Red and puffy gums – Gums should never be red or swollen.

• Bleeding gums – Gums should never bleed, even when you brush vigorously or use dental floss.

• Persistent bad breath – Caused by bacteria in the mouth.

• New spacing between teeth – Caused by bone loss.

• Loose teeth – Also caused by bone loss or weakened periodontal fibers (fibers that support the tooth to the bone).

• Pus around the teeth and gums – Sign that there is an infection present.

• Receding gums – Loss of gum around a tooth.

• Tenderness or Discomfort – Plaque, calculus, and bacteria irritate the gums and teeth.

Good oral hygiene, a balanced diet, and regular dental visits can help reduce your risk of developing periodontal disease.

Brushing our teeth removes food particles, plaque, and bacteria from all tooth surfaces, except in between the teeth.  Unfortunately, our toothbrush can’t reach these areas that are highly susceptible to decay and periodontal (gum) disease.

Daily flossing is the best way to clean between the teeth and under the gumline.  Flossing not only helps clean these spaces, it disrupts plaque colonies from building up, preventing damage to the gums, teeth, and bone.

Plaque is a sticky, almost invisible film that forms on the teeth.  It is a growing colony of living bacteria, food debris, and saliva.  The bacteria produce toxins (acids) that cause cavities and irritate and inflame the gums.  Also, when plaque is not removed above and below the gumline, it hardens and turns into calculus (tartar).  This will further irritate and inflame the gums and also slowly destroy the bone.  This is the beginning of periodontal disease.

How to floss properly:

• Take 12-16 inches (30-40cm) of dental floss and wrap it around your middle fingers, leaving about 2 inches (5cm) of floss between the hands.
• Using your thumbs and forefingers to guide the floss, gently insert the floss between teeth using a sawing motion.
• Curve the floss into a “C” shape around each tooth and under the gumline.  Gently move the floss up and down, cleaning the side of each tooth.

Floss holders are recommended if you have difficulty using conventional floss.

Daily flossing will help you keep a healthy, beautiful smile for life!

Since teeth whitening has now become the number one aesthetic concern of many patients, there are many products and methods available to achieve a brighter smile.

Professional teeth whitening (or bleaching) is a simple, non-invasive dental treatment used to change the color of natural tooth enamel, and is an ideal way to enhance the beauty of your smile.  Over-the-counter products are also available, but they are much less effective than professional treatments and may not be approved by the American Dental Association (ADA).

As we age, the outer layer of tooth enamel wears away, eventually revealing a darker or yellow shade.  The color of our teeth also comes from the inside of the tooth, which may become darker over time.  Smoking, drinking coffee, tea, and wine may also contribute to tooth discoloration, making our teeth yellow and dull.  Sometimes, teeth can become discolored from taking certain medications as a child, such as tetracycline.  Excessive fluoridation (fluorosis) during tooth development can also cause teeth to become discolored.

It’s important to have your teeth evaluated by your dentist to determine if you’re a good candidate for bleaching.  Occasionally, tetracycline and fluorosis stains are difficult to bleach and your dentist may offer other options, such as veneers or crowns to cover up such stains.  Since teeth whitening only works on natural tooth enamel, it is also important to evaluate replacement of any old fillings, crowns, etc. before bleaching begins.  Once the bleaching is done, your dentist can match the new restorations to the shade of the newly whitened teeth.

Since teeth whitening is not permanent, a touch-up may be needed every several years to keep your smile looking bright.

The most widely used professional teeth whitening systems:

Home teeth whitening systems: At-home products usually come in a gel form that is placed in a custom-fitted mouthguard (tray), created from a mold of your teeth.  The trays are worn either twice a day for approximately 30 minutes, or overnight while you sleep.  It usually takes several weeks to achieve the desired results depending on the degree of staining and the desired level of whitening.

In office teeth whitening: This treatment is done in the dental office and you will see results immediately.  It may require more than one visit, with each visit lasting 30 to 60 minutes.  While your gums are protected, a bleaching solution is applied to the teeth.  A special light may be used to enhance the action of the agent while the teeth are whitened.

Some patients may experience tooth sensitivity after having their teeth whitened.  This sensation is temporary and subsides shortly after you complete the bleaching process, usually within a few days to one weak.

With many state-of-the-art dental treatments and prevention options available in dentistry today, there are fewer reasons for having to extract (remove) teeth.  When something does go wrong with a tooth, we try to do everything possible to restore the tooth to its original function.  Removing a tooth is the last option because we know that removal may lead to severe and costly dental and cosmetic problems if the tooth is not replaced.

Losing a tooth can be a very traumatic experience and it’s very unfortunate when it does happen.  Injury, accident, fracture, severe dental decay, and gum disease are the major reasons for having to remove a tooth.  If teeth are lost due to injury or have to be removed, it is imperative that they be replaced to avoid cosmetic and dental problems in the future.

When a tooth is lost, the jaw bone that helped to support that tooth begins to atrophy, causing the teeth on either side to shift or tip into the open space of the lost tooth.  Also, the tooth above or below the open space will start to move towards the open space because there is no opposing tooth to bite on.  These movements may create problems such as decay, gum disease, excessive wear on certain teeth, and TMJ (jaw joint) problems.  These problems and movements do not result immediately, but will eventually appear, compromising your chewing abilities, the health of your bite, and the beauty of your smile.

Options for replacement of missing teeth:

Removable bridges - This type of bridge is a good solution for replacing one or more missing teeth, especially in complex dental situations where other replacement options are not possible. They are usually made of tooth-colored, artificial teeth combined with metal clasps that hook onto adjacent natural teeth. Removable bridges are the most economical option for replacing missing teeth, but may be the least aesthetically pleasing. This is because the metal clasps on the appliances are often impossible to completely conceal.

Fixed bridges - This type of bridge is generally made of porcelain or composite material and is anchored (cemented) permanently to a natural teeth adjacent to the missing tooth site. The benefit of this type of bridge is that it is fixed (not removable) and it is very sturdy. The disadvantage is that in order to create a fixed appliance, two healthy, natural teeth will have to be crowned (capped) to hold the bridge in place.

Dentures - This type of tooth replacement is used when most or all of the natural teeth are missing in one dental arch. Dentures are removable artificial teeth that are made to closely resemble the patients’ original teeth.

Implants - Are a great way to replace one or more missing teeth. They may also be great to support ill fitting dentures. A dental implant is an artificial root that is surgically placed into the jaw bone to replace a missing tooth. An artificial tooth is placed on the implant, giving the appearance and feel of a natural tooth. Implants are very stable, durable, and are the most aesthetically pleasing tooth replacement option.

If you are missing teeth, ask us if they need replacement and what options are available to you. Together we will select the best replacement option for your particular case. Prevention and early treatment is always less involved and less costly than delaying treatment and allowing a serious problem to develop.

Most of us have fillings in our mouths that date back many years and some may have even been placed during our childhood. These fillings may now be old, dark, and unattractive, making us feel self-conscious when we smile, laugh, and talk. Old fillings are not only unattractive, they may also be defective. When a filling is old, the margins (space between the tooth and filling) may eventually open and allow bacteria and food debris to enter, potentially causing dental decay.

Your dentist can check your fillings and evaluate if they are defective and need replacement. Also, if you simply want to replace fillings that are unattractive, you and your dentist can decide which ones should be replaced first and what replacement options would best suit you. There are many state-of-the-art dental filling materials and procedures available today that are quick, painless, and cost effective for replacing old, unattractive or defective fillings.

Options for replacing old, unattractive, or discolored fillings:

Composite (bonding) fillings - These are tooth-colored fillings that can be closely matched to the color of your existing teeth. They are particularly well suited for use in front teeth or visible parts of teeth and are one of the best ways to improve the health and beauty of your smile.

Crowns (Caps) - These types of restoration are used when a tooth is too damaged and cannot be repaired with a filling or other type of restoration. A crown is a covering that encases the entire tooth surface restoring it to its original shape and size. A crown protects and strengthens the remaining tooth structure and can be made of gold, porcelain, and other tooth-colored materials.

Inlays/Onlays - These restorations are custom made fillings. They can be made of composite resin, porcelain or gold and are made by a dental laboratory and placed by a dentist. Inlays/onlays are usually best for the posterior chewing surfaces of teeth and are utilized to conservatively repair teeth that have large defective/unattractive fillings or have been damaged by decay or trauma.

Porcelain veneers - Used primarily in the front teeth, veneers are very thin shells of tooth-shaped porcelain that are individually crafted and permanently cemented to the front surface of teeth. They are a great solution for fixing discolored, pitted, shipped, malformed, or slightly crooked teeth. Veneers are also used if you have unwanted spaces. Veneers are very durable, natural looking, and do not stain. This makes veneers a very popular solution for restoring a smile impaired by old, unattractive fillings.

As you can see, there are various options for replacing old, unattractive fillings. These treatments will provide strong, natural, and long-lasting replacement solutions to enhance the health and beauty of your smile.

Many people are unaware that having periodontal disease (the destruction of gum tissue and bone that hold our teeth in place) can affect your overall health.  Periodontal disease is one of the most common infections; often more prevalent than the common cold!  Periodontal disease is not only the number one reason people lose teeth; it can also affect the health of your body!

Periodontal disease is a bacterial infection, and in its earliest stages, it’s called gingivitis.  It starts when an accumulation of plaque (a colony of bacteria, food debris, and saliva) is NOT regularly removed from the gums and teeth.  The bacteria in plaque produce toxins/acids that irritate and infect the gums and eventually destroy the jaw bone that supports the teeth.  When periodontal disease is not treated it can eventually lead to tooth loss!

There are numerous studies that have looked into the correlation between gum disease and major medical conditions.  These studies suggest people with periodontal disease are at a greater risk of systemic disease and indicate that periodontal disease may cause oral bacteria to enter the bloodstream and travel to major organs and begin new infections.  Research suggests that periodontal bacteria in the blood stream may:

• Contribute to the development of heart disease
• Increase the risk of stroke
• Compromise the health of those that have diabetes or respiratory diseases
• Increase a woman’s risk of having a preterm, low-birth weight baby

Researchers conclude there is still much research to be done to understand the link between periodontal disease and systemic diseases, but enough research has been done to support that infections in the mouth can play havoc elsewhere in the body.

To ensure a healthy, disease-free mouth, we recommend the importance of regular dental check-ups and cleanings, which include a periodontal evaluation.  Also, diligent home care and a proper diet can help reduce the plaque and bacteria in the mouth.

Remember….the mouth body connection!  Taking care of your oral health may contribute to your overall medical health!

Although thorough brushing and flossing remove most food particles and bacteria from easy to reach tooth surfaces, they do not reach the deep grooves on chewing surfaces of teeth. More than 75 percent of dental decay begins in these deep grooves (called pits and fissures). Toothbrush bristles are too large to possibly fit and clean most of these areas. This is where sealants play an important role.

A sealant is a thin plastic coating that covers and protects the chewing surfaces of molars, premolars, and any deep grooves or pits on teeth. Sealant material forms a protective, smooth barrier covering natural depressions and grooves in the teeth, making it much easier to clean and help keep these areas free of decay.

Who may need sealants?

Children and teenagers - As soon as the six-year molars (the first permanent back teeth) appear or any time throughout the cavity prone years of 6-16.

Infants - Baby teeth are occasionally sealed if the teeth have deep grooves and the child is cavity prone.

Adults - Tooth surfaces without decay that have deep grooves or depressions that are difficult to clean.

Sealants are easily applied by your dentist or dental hygienist and the process only takes minutes per tooth. After the chewing surfaces are roughened with an acid solution that helps the sealant adhere to the tooth, the sealant material is “painted” onto the tooth surface, where it hardens and bonds to the teeth. Sometimes a special light will be used to help the sealant material harden.

After sealant treatment, it’s important to avoid chewing on ice cubes, hard candy, popcorn kernels, or any hard or sticky foods. Your sealants will be checked for wear and chipping at your regular dental check-up.

Combined with good home care, a proper diet, and regular dental check-ups, sealants are very effective in helping prevent tooth decay.

We’re all at risk for having a tooth knocked out.  More than 5 million teeth are knocked out every year!  If we know how to handle this emergency situation, we may be able to actually save the tooth.  Teeth that are knocked out may be possibly reimplanted if we act quickly, yet calmly, and follow these simple steps:

1. Locate the tooth and handle it only by the crown (chewing part of the tooth), NOT by the roots.
2. DO NOT scrub or use soap or chemicals to clean the tooth.  If it has dirt or debris on it, rinse it gently with your own saliva or whole milk.  If that is not possible, rinse it very gently with water.
3. Get to a dentist within 30 minutes.  The longer you wait, the less chance there is for successful reimplantation.

Ways to transport the tooth

• Try to replace the tooth back in its socket immediately.  Gently bite down on gauze, a wet tea bag or on your own teeth to keep the tooth in place.  Apply a cold compress to the mouth for pain and swelling as needed.
• If the tooth cannot be placed back into the socket, place the tooth in a container and cover with a small amount of your saliva or whole milk.  You can also place the tooth under your tongue or between your lower lip and gums.  Keep the tooth moist at all times.  Do not transport the tooth in a tissue or cloth.
• Consider buying a “Save-A-Tooth” storage container and keeping it as part of your home first aid kit.  The kit is available in many pharmacies and contains a travel case and fluid solution for easy tooth transport.

The sooner the tooth is replaced back into the socket, the greater the likelihood it has to survive and possibly last for many years.  So be prepared, and remember these simple steps for saving a knocked-out tooth.

You can prevent broken or knocked-out teeth by:

• Wearing a mouthguard when playing sports
• Always wearing your seatbelt
• Avoiding fights
• Avoid chewing hard items such as ice, popcorn kernels, hard breads, etc.

Straighter teeth perform chewing, biting and speaking functions more effectively than crooked teeth.  In addition, a straight smile boosts confidence, is aesthetically pleasing to look at, and can help stave off a wide variety of dental ailments.

There are several types of malocclusion including overbite, underbite, crossbite, and overcrowding.  Each of these alignment problems negatively impacts the functionality and cosmetic appearance of the teeth.

Here is a brief overview of some of the main disorders associated with crooked teeth:

Periodontitis – Periodontitis or gum disease begins with a bacterial infection.  The bacterial infection is caused by inadequate oral hygiene.  Crooked teeth are hard to clean effectively, which means that debris, plaque and bacteria can build up in hard-to-reach areas.  Straight teeth are much easier to clean and are at less risk of contracting gum disease.

Temporomandibular Disorder (TMJ) - Crooked teeth can lead to improper jaw alignment, which in turn causes a painful condition known as TMJ.  Severe headaches, jaw pain, lockjaw and the grinding of teeth characterize this debilitating disorder.

Tooth injury – Straight teeth creates a strong wall, which means injuries are less likely to occur.  Crooked teeth are weaker and often protrude, making them far more vulnerable to external injury.

Uneven wear – Crooked teeth cause some of the teeth to work harder than others when biting and chewing.  Straight teeth share the workload evenly, meaning less risk of injury and better aesthetics.

Teeth can be straightened using either orthodontic braces or customized aligning trays.  Orthodontic braces are usually affixed to the teeth for a set duration.  The brackets and archwires are tightened regularly by the orthodontist and removed when treatment is complete.  Fixed braces can be placed on the front side or back side of the teeth and are effective for most types of malocclusion.

Aligning trays are fully removable and are used where the malocclusion is less severe, and the teeth need to move a shorter distance.  These trays are replaced every few weeks for the duration of the treatment, and have proven to be equally effective for straightening teeth.

If you have questions about orthodontics and straightening teeth, please ask your orthodontist.

The term “periodontal”means “around the tooth.”  Periodontal disease (also known as periodontitis and gum disease) is a common inflammatory condition which affects the supporting and surrounding soft tissues of the tooth; also the jawbone itself when in its most advanced stages.

Periodontal disease is most often preceded by gingivitis which is a bacterial infection of the gum tissue.  A bacterial infection affects the gums when the toxins contained in plaque begin to irritate and inflame the gum tissues.  Once this bacterial infection colonizes in the gum pockets between the teeth, it becomes much more difficult to remove and treat.  Periodontal disease is a progressive condition that eventually leads to the destruction of the connective tissue and jawbone.  If left untreated, it can lead to shifting teeth, loose teeth and eventually tooth loss.

Periodontal disease is the leading cause of tooth loss among adults in the developed world and should always be promptly treated.

Types of Periodontal Disease

When left untreated, gingivitis (mild gum inflammation) can spread to below the gum line.  When the gums become irritated by the toxins contained in plaque, a chronic inflammatory response causes the body to break down and destroy its own bone and soft tissue.  There may be little or no symptoms as periodontal disease causes the teeth to separate from the infected gum tissue.  Deepening pockets between the gums and teeth are generally indicative that soft tissue and bone is being destroyed by periodontal disease.

Here are some of the most common types of periodontal disease:

• Chronic periodontitis – Inflammation within supporting tissues cause deep pockets and gum recession.  It may appear the teeth are lengthening, but in actuality, the gums (gingiva) are receding.  This is the most common form of periodontal disease and is characterized by progressive loss of attachment, interspersed with periods of rapid progression.
  
  
• Aggressive periodontitis – This form of gum disease occurs in an otherwise clinically healthy individual.  It is characterized by rapid loss of gum attachment, chronic bone destruction and familial aggregation.
  
  
• Necrotizing periodontitis – This form of periodontal disease most often occurs in individuals suffering from systemic conditions such as HIV, immunosuppression and malnutrition.  Necrosis (tissue death) occurs in the periodontal ligament, alveolar bone and gingival tissues.
  
  
• Periodontitis caused by systemic disease – This form of gum disease often begins at an early age.  Medical condition such as respiratory disease, diabetes and heart disease are common cofactors.

Treatment for Periodontal Disease

There are many surgical and nonsurgical treatments the periodontist may choose to perform, depending upon the exact condition of the teeth, gums and jawbone.  A complete periodontal exam of the mouth will be done before any treatment is performed or recommended.

Here are some of the more common treatments for periodontal disease:

• Scaling and root planing – In order to preserve the health of the gum tissue, the bacteria and calculus (tartar) which initially caused the infection, must be removed.  The gum pockets will be cleaned and treated with antibiotics as necessary to help alleviate the infection.  A prescription mouthwash may be incorporated into daily cleaning routines.
  
  
• Tissue regeneration – When the bone and gum tissues have been destroyed, regrowth can be actively encouraged using grafting procedures.  A membrane may be inserted into the affected areas to assist in the regeneration process.
  
  
• Pocket elimination surgery – Pocket elimination surgery (also known as flap surgery) is a surgical treatment which can be performed to reduce the pocket size between the teeth and gums.  Surgery on the jawbone is another option which serves to eliminate indentations in the bone which foster the colonization of bacteria.
  
  
• Dental implants – When teeth have been lost due to periodontal disease, the aesthetics and functionality of the mouth can be restored by implanting prosthetic teeth into the jawbone.  Tissue regeneration procedures may be required prior to the placement of a dental implant in order to strengthen the bone.

Ask your dentist if you have questions or concerns about periodontal disease, periodontal treatment, or dental implants.

The American Academy of Pediatric Dentists (AAPD) advises parents to make biannual dental appointments for children, beginning approximately six months after the first tooth emerges.

These two important yearly visits allow the pediatric dentist to monitor new developments in the child’s mouth, evaluate changes in the condition of teeth and gums, and continue to advise parents on good oral care strategies.

The dentist may schedule additional visits for children who are particularly susceptible to tooth decay or who show early signs of orthodontic problems.

What is the purpose of dental checkups?

First, we aim to provide a “good dental home” for the child.  If a dental emergency does arise, parents can take the child for treatment at a familiar, comfortable location.

Second, we keep meticulous records of the child’s ongoing dental health and jaw development.  In general, painful dental conditions do not arise overnight.  If the dentist understands the child’s dental health history, it becomes easier to anticipate future issues and intervene before they arise.

Third, we are able to educate parents and children during the visit.  Sometimes the dentist wants to introduce one or several factors to enhance tooth health - for example, sealants, fluoride supplements, or xylitol.  Other times, the dentist asks parents to change the child’s dietary or oral behavior - for example, reducing sugar in the child’s diet, removing an intraoral piercing, or even transitioning the child from sippy cups to adult-sized drinking glasses.

Finally, dental X-rays are often the only way to identify tiny cavities in primary (baby) teeth.  Though the child may not be feeling any pain, left unchecked, these tiny cavities can rapidly turn into large cavities, tooth decay, and eventually, childhood periodontal disease.  Dental X-rays are only used when the dentist suspects cavities or orthodontic irregularities.

Are checkups necessary if my child has healthy teeth?

The condition of a child’s teeth can change fairly rapidly.  Even if the child’s teeth were evaluated as healthy just six months prior, changes in diet or oral habits (for example, thumb sucking) can quickly render them vulnerable to decay or misalignment.

In addition to visual examinations, the dentist provides thorough dental cleanings during each visit.  These cleanings eradicate the plaque and debris that can build up between teeth and in other hard to reach places.  Though a good homecare routine is especially important, these professional cleanings provide an additional tool to keep smiles healthy.

The dentist also able to monitor the child’s fluoride levels during routine visits.  Oftentimes, a topical fluoride gel or varnish is applied to teeth after the cleaning.  Topical fluoride remineralizes the teeth and staunches mineral loss, protecting tooth enamel from oral acid attacks.  Some children are also given take-home fluoride supplements (especially those residing in areas where fluoride is not routinely added to the community water supply).

Finally, the dentist may apply dental sealants to the child’s back teeth (molars).  This impenetrable liquid plastic substance is brushed onto the molars to seal out harmful debris, bacteria, and acid.

If you have questions or concerns about when to schedule your child’s dental checkups please contact us.

The “pulp” of a tooth cannot be seen with the naked eye. Pulp is found at the center of each tooth, and is comprised of nerves, tissue, and many blood vessels, which work to channel vital nutrients and oxygen.  There are several ways in which pulp can be damaged.  Most commonly, tooth decay or traumatic injury lead to painful pulp exposure and inflammation.

Pulp therapy is known by several other names, including: root canal, pulpotomy, pulpectomy, and nerve treatment.  The primary goal of pulp therapy is to treat, restore, and save the affected tooth.

Dentists can perform pulp therapy on both primary (baby) teeth and permanent teeth.  Though primary teeth are eventually shed, they are needed for speech production, proper chewing, and to guide the proper alignment and spacing of permanent teeth.

What are the signs of pulp injury and infection?

Inflamed or injured pulp is exceptionally painful.  Even if the source of the pain isn’t visible, it will quickly become obvious that a dental appointment is needed.

Here are some of the other signs to look for:

• Constant unexplained pain.
• Nighttime pain.
• Sensitivity to warm and cool food temperatures.
• Swelling or redness around the affected tooth.
• Unexpected looseness or mobility of the affected tooth.

When should a patient undergo pulp therapy?

Every situation is unique.  The dentist assesses the age of the patient, the positioning of the tooth, and the patient's general health before making a recommendation to extract the tooth or to save it via pulp therapy.

Some of the undesirable consequences of prematurely extracted/missing teeth are listed below:

• Arch length may shorten.
• In the case of primary tooth loss, permanent teeth may lack sufficient space to emerge.
• Opposing teeth may grow in a protruding or undesirable way.
• Premolars may become painfully impacted.
• Remaining teeth may “move” to fill the gap.
• The tongue may posture abnormally.

How is pulp therapy performed?

Initially, the dentist will perform visual examinations and evaluate X-rays of the affected areas.  The amount and location of pulp damage dictates the nature of the treatment.  Although there are several other treatments available, the pulpotomy and pulpectomy procedures are among the most common performed.

Pulpotomy - If the pulp root remains unaffected by injury or decay, meaning that the problem is isolated in the pulp tip, the dentist may leave the healthy part alone and only remove the affected pulp and surrounding tooth decay.  The resulting gap is then filled with a biocompatible, therapeutic material, which prevents infection and soothes the pulp root. Most commonly, a crown is placed on the tooth after treatment.  The crown strengthens the tooth structure, minimizing the risk of future fractures.

Pulpotomy treatment is extremely versatile.  It can be performed as a standalone treatment or as the initial step in a full root canal treatment.

Pulpectomy - In the case of severe tooth decay or trauma, the entire tooth pulp (including the root canals) may be affected.  In these circumstances, the dentist must remove the pulp, cleanse the root canals, and then pack the area with biocompatible material.  This usually takes several office visits.

The final treatment step is to place a crown on the tooth to add strength and provide structural support.  

If you have questions or concerns about the pediatric pulp therapy procedure, please contact your dentist.

Evaluating the many brands of oral products claiming to be “best for children” can be an overwhelming task.  Selecting an appropriately sized toothbrush and a nourishing, cleansing brand of children’s toothpaste is of paramount importance for maintaining excellent oral health.

Why brush primary teeth?

The importance of maintaining the health of primary (baby) teeth is often understated.  Primary teeth are essential for speech production, chewing, jaw development, and they also facilitate the proper alignment and spacing of permanent adult teeth.  Brushing primary teeth prevents bad breath and tooth decay, and also removes the plaque bacteria associated with childhood periodontal disease.

What differences are there among toothpaste brands?

Though all toothpastes are not created equal, most brands generally contain abrasive ingredients to remove stains, soapy ingredients to eliminate plaque, fluorides to strengthen tooth enamel, and some type of pleasant-tasting flavoring.

The major differences between brands are the thickness of the paste, the level of fluoride content, and the type of flavoring.  Although fluoride strengthens enamel and repels plaque bacteria, too much of it can actually harm young teeth – a condition known as dental fluorosis.  Children between the ages of one and four years old are most at risk for this condition, so fluoride levels should be carefully monitored during this time.

Be aware that adult and non-ADA approved brands of toothpaste often contain harsher abrasives, which remove tooth enamel and weaken primary teeth.  In addition, some popular toothpaste brands contain sodium lauryl sulfate (shown as “SLS” on the package), which cause painful mouth ulcers in some children.

So which toothpaste brand should I choose?

The most important considerations to make before implementing an oral care plan and choosing a toothpaste brand is the age of the child.  Home oral care should begin before the emergence of the first tooth.  A cool clean cloth should be gently rubbed along the gums after feeding to remove food particles and bacteria.

Prior to the age of two, the child will have many teeth and brushing should begin.  Initially, select fluoride-free “baby” toothpaste and softly brush the teeth twice per day.  Flavoring is largely unimportant, so the child can play an integral role in choosing whatever type of toothpaste tastes most pleasant.

Between the middle and the end of the third year, select an American Dental Association (ADA) accepted brand of toothpaste containing fluoride.  The ADA logo is clear and present on toothpaste packaging, so be sure to check for it.  Use only a tiny pea or rice-sized amount of fluoride toothpaste, and encourage the child to spit out the excess after brushing.  Eliminating the toothpaste takes practice, patience, and motivation – especially if the child finds the flavoring tasty.  If the child does ingest tiny amounts of toothpaste, don’t worry; this is perfectly normal and will cease with time and encouragement.

Dental fluorosis is not a risk factor for children over the age of eight, but an ADA accepted toothpaste is always the recommended choice for children of any age.

If you have questions or concerns about choosing an appropriate brand of toothpaste for your child, your dentist will be happy to make recommendations.

Biannual visits with the pediatric dentist are only part of the battle against cavities.  Here are some helpful guidelines for cavity prevention:

1. Analyze the diet – Too many sugary or starchy snacks can expedite cavity formation.  Replace sugary snacks like candy with natural foods where possible, and similarly replace soda with water.
2. Cut the snacks – Snacking too frequently can unnecessarily expose teeth to sugars.  Save the sugar and starch for mealtimes, when the child is producing more saliva, and drinking water.  Make sure they consume enough water to cleanse the teeth.
3. Lose the sippy cup – Sippy cups are thought to cause “baby bottle tooth decay” when they are used beyond the intended age (approximately twelve months).  The small amount of liquid emitted with each sip causes sugary liquid to continually swill around the teeth.
4. Avoid stickiness – Sticky foods (like toffee) form plaque quickly, and are extremely difficult to pry off the teeth.  Avoid them where possible.
5. Rinse the pacifier – Oral bacteria can be transmitted from mother or father to baby.  Rinse a dirty pacifier with running water as opposed to sucking on it, to avoid contaminating the baby’s mouth.
6. Drinks at bedtime – Sending a child to bed with a bottle or sippy cup is bad news.  The milk, formula, juice, or sweetened water basically sits on the teeth all night – attacking enamel and maximizing the risk of cavities.  Ensure the child has a last drink before bedtime, and then brush the teeth.
7. Don’t sweeten the pacifier – Parents sometimes dip pacifiers in honey to calm a cranky child.  Do not be tempted to do this.  Use a blanket, toy, or hug to calm the child instead.
8. Brush and floss – Parents should brush and floss their child’s teeth twice each day until the child reaches the age of seven years old.  Before this time, children struggle to brush every area of the mouth effectively.
9. Check on fluoride –When used correctly, fluoride can strengthen tooth enamel and help stave off cavities.  Too much or too little fluoride can actually harm the teeth, so ask the pediatric dentist for a fluoride assessment.
10. Keep to appointments – The child’s first dental visit should be scheduled around his or her first birthday, as per the American Academy of Pediatric Dentistry (AAPD) guidelines.  Keep to a regular appointment schedule to create healthy smiles!

If you have questions or concerns about cavity prevention, please contact your dentist.